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. 2025 Jan;60(1):1-24.
doi: 10.1007/s00127-024-02739-6. Epub 2024 Jul 30.

Variations in definitions used for describing restrictive care practices (seclusion and restraint) in adult mental health inpatient units: a systematic review and content analysis

Zelalem Belayneh Muluneh  1   2 , Jacinta Chavulak  3 , Den-Ching A Lee  3   4   5 , Melissa Petrakis  3   6 , Terry P Haines  3   5
Affiliations

Variations in definitions used for describing restrictive care practices (seclusion and restraint) in adult mental health inpatient units: a systematic review and content analysis

Zelalem Belayneh Muluneh et al. Soc Psychiatry Psychiatr Epidemiol. 2025 Jan.

Abstract

Purpose: The main purpose of this review was to (1) identify thematic elements within definitions used by recently published literature to describe the constructs of physical/mechanical restraint, seclusion and chemical restraint in adult mental health inpatient units.

Methods: We conducted a comprehensive literature search of six databases (Scopus, MEDLINE, PsycINFO, Web of Science, Embase, and CINAHL-Plus). In this review, we conducted content analysis to synthesize evidence to understand and compare the commonalities and discrepancies in conceptual elements that were incorporated within the definitions of different forms of restrictive care practices.

Results: A total of 95 studies that provided definitions for different forms of restrictive care practices [physical/mechanical restraint (n = 72), seclusion (n = 65) and chemical restraint (n = 19)] were included in this review. Significant variations existed in the conceptual domains presented within the applied definitions of physical/mechanical restraint, seclusion, and chemical restraint. Conceptual themes identified in this review were methods of restrictive care practice, reasons and desired outcomes, the extent of patient restriction during restrictive care practice episodes, timing (duration, frequency, and time of the day), the level of patient autonomy, and the personnel implementing these practices.

Conclusions: Inconsistencies in the terminologies and conceptual boundaries used to describe the constructs of different forms of restrictive care practices underscore the need to move forward in endorsing consensus definitions that reflect the diverse perspectives, ensuring clarity and consistency in practice and research. This will assist in validly measuring and comparing the actual trends of restrictive care practice use across different healthcare institutions and jurisdictions.

Keywords: Classification; Coercion; Definition; Immobilization; Mental health; Perception; Restraint; Restrictive practice; Seclusion; Understanding.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of systematic literature search and study selectionusing PRISMA. Note: Some studies had definitions for more than one of the review outcomes that the sum of studies included to in the analysis of physical/mechnical restraint, seclusion and chemical restraint is greater than 95
Fig. 2
Fig. 2
Emergent conceptual themes identified from definitions used by published studies to describe the constructs of physical/mechanical restraint, seclusion and chemical restraint in adult mental health inaptients
See this image and copyright information in PMC

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